Open Access Research article

CA 15-3 is predictive of response and disease recurrence following treatment in locally advanced breast cancer

Dhafir Al-azawi13*, Gabrielle Kelly2, Eddie Myers3, Enda W McDermott1, Arnold DK Hill13, Michael J Duffy4 and Niall O Higgins1

Author Affiliations

1 Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland

2 School of Mathematical Sciences, University College Dublin, Dublin, Ireland

3 Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin, Ireland

4 Department of Nuclear Medicine, St. Vincent's University Hospital, Dublin, Ireland

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BMC Cancer 2006, 6:220  doi:10.1186/1471-2407-6-220

Published: 5 September 2006

Abstract

Background

Primary chemotherapy (PC) is used for down-staging locally advanced breast cancer (LABC). CA 15-3 measures the protein product of the MUC1 gene and is the most widely used serum marker in breast cancer.

Methods

We retrospectively investigated the role of CA 15-3 in conjunction with other clinico-pathological variables as a predictor of response and time to disease recurrence following treatment in LABC. Pre and post primary chemotherapy serum concentrations of CA 15-3 together with other variables were reviewed and related to four outcomes following primary chemotherapy (clinical response, pathological response, time to recurrence and time to progression). Persistently elevated CA 15-3 after PC was considered as consecutively high levels above the cut off point during and after PC.

Results

73 patients were included in this study. Patients received PC (AC or AC-T regimen) for locally advanced breast cancer. 54 patients underwent surgery. The median follow up was 790 days. Patients with high concentrations of CA 15-3 before PC treatment had a poor clinical (p = 0.013) and pathological (p = 0.044) response. Together with Her-2/neu expression (p = 0.009) and tumour lympho-vascular space invasion (LVI) (p = 0.001), a persistently elevated CA 15-3 post PC (p = 0.007) was an independent predictive factor of recurrence following treatment in LABC.

Conclusion

Elevated CA 15-3 level is predictive of a poor response to chemotherapy. In addition, persistently elevated CA 15-3 levels post chemotherapy in conjunction with lympho-vascular invasion and HER2 status predict a reduced disease free survival following treatment in locally advanced breast cancer.